3. Obsession with weight and complaining of weight problems (even if “average” weight or thin).

4. Obsession with calories and fat content of foods.

5. Obsession with continuous exercise.

6. Frequent trips to the bathroom immediately following meals (sometimes accompanied with water running in the bathroom for a long period of time to hide the sound of vomiting).

7. Unusual food rituals such as shifting the food around on the plate to look eaten; cutting food into tiny pieces; making sure the fork avoids contact with the lips (using teeth to scrape food off the fork or spoon); chewing food and spitting it out, but not swallowing; dropping food into napkin on lap to later throw away.

But on the inside, she was fighting a battle that stripped her of any joy. She lacked energy and self esteem; she was a perfectionist who thought nothing she did was ever good enough.

Cox, who is now 17, developed an eating disorder when she was in the seventh grade. She dealt with bouts of anorexia, bulimia and even binge eating at times.

Friends, family members and teachers didn't know she had a problem. Even Cox wouldn't admit she had a problem, if asked.

She thought she was healthy and what she was doing was normal.

“That's the thing with eating disorders,” the Spartanburg High School student said on a recent Thursday morning. “They thrive in secrecy.”

Eating disorders affect more than 35 million Americans, according to the National Eating Disorders Association, It's not just a female problem, about seven million of those affected are males.

More people die from eating disorders than from any other psychiatric illness.

“It's an illness that most people do not understand,” said Cox, who finally broke and admitted her problem to her parents in ninth grade. “When you look around town you can't go into someone's mind and see what they are thinking and see what is going on.”

In Spartanburg, schools are now being taught how to better understand the issue that plagues so many.

On a recent Wednesday, about 60 guidance counselors and nurses from all Spartanburg County school districts gathered in a classroom at Spartanburg High School and received twohour training on how to recognize, approach and treat students who have eating disorders. The trainees will take what they learned back to their schools and teach others.

The training was led by Mental Fitness Inc., a New York-based nonprofit that recently moved its headquarters to Spartanburg. The nonprofit works with schools to raise awareness of mental health, eating disorders, body image and stress management.

“This is a national movement to raise awareness in schools about these issues that no one really is talking about,” said Robyn Hussa, founder and CEO of Mental Fitness Inc. “By raising awareness through strategic and collaborative trainings, we hope to assist communities in reducing the number of sufferers of eating disorders and other mental illnesses and enhance the mental fitness of every child in Spartanburg.”

Dr. Terry Pruitt, deputy superintendent of School District 7, said the training was rolled out in District 7 schools last year. District 7 agreed to host additional training for other schools.

“This is something that we thought would be valuable to all of our school districts,” Pruitt said. “We are excited to have this resource. As we look at statistics nationwide, eating disorders are a bigger problem than many realize, and it's certainly more than anorexia or bulimia. We are learning a lot.”

He said schools, once they recognize a problem, can help steer the students and their parents to the best resources for help.

Now that Cox has recovered from her eating disorders, and is “as free as she has ever been,” she educates others about the issues she faced. She attended the training session and answered questions asked by nurses and guidance counselors.

“Raising awareness is so important,” she said. “This is a growing problem, and many of the issues go unrecognized.”

<p>SPARTANBURG, S.C. — Eliza Cox appeared to be a normal, healthy teenage girl with an infectious smile and an outgoing personality.</p><p>But on the inside, she was fighting a battle that stripped her of any joy. She lacked energy and self esteem; she was a perfectionist who thought nothing she did was ever good enough.</p><p>Cox, who is now 17, developed an eating disorder when she was in the seventh grade. She dealt with bouts of anorexia, bulimia and even binge eating at times.</p><p>Friends, family members and teachers didn't know she had a problem. Even Cox wouldn't admit she had a problem, if asked.</p><p>She thought she was healthy and what she was doing was normal.</p><p>“That's the thing with eating disorders,” the Spartanburg High School student said on a recent Thursday morning. “They thrive in secrecy.”</p><p>Eating disorders affect more than 35 million Americans, according to the National Eating Disorders Association, It's not just a female problem, about seven million of those affected are males.</p><p>More people die from eating disorders than from any other psychiatric illness.</p><p>“It's an illness that most people do not understand,” said Cox, who finally broke and admitted her problem to her parents in ninth grade. “When you look around town you can't go into someone's mind and see what they are thinking and see what is going on.”</p><p>In Spartanburg, schools are now being taught how to better understand the issue that plagues so many.</p><p>On a recent Wednesday, about 60 guidance counselors and nurses from all Spartanburg County school districts gathered in a classroom at Spartanburg High School and received twohour training on how to recognize, approach and treat students who have eating disorders. The trainees will take what they learned back to their schools and teach others.</p><p>The training was led by Mental Fitness Inc., a New York-based nonprofit that recently moved its headquarters to Spartanburg. The nonprofit works with schools to raise awareness of mental health, eating disorders, body image and stress management.</p><p>“This is a national movement to raise awareness in schools about these issues that no one really is talking about,” said Robyn Hussa, founder and CEO of Mental Fitness Inc. “By raising awareness through strategic and collaborative trainings, we hope to assist communities in reducing the number of sufferers of eating disorders and other mental illnesses and enhance the mental fitness of every child in Spartanburg.”</p><p>Dr. Terry Pruitt, deputy superintendent of School District 7, said the training was rolled out in District 7 schools last year. District 7 agreed to host additional training for other schools.</p><p>“This is something that we thought would be valuable to all of our school districts,” Pruitt said. “We are excited to have this resource. As we look at statistics nationwide, eating disorders are a bigger problem than many realize, and it's certainly more than anorexia or bulimia. We are learning a lot.”</p><p>He said schools, once they recognize a problem, can help steer the students and their parents to the best resources for help.</p><p>Now that Cox has recovered from her eating disorders, and is “as free as she has ever been,” she educates others about the issues she faced. She attended the training session and answered questions asked by nurses and guidance counselors.</p><p>“Raising awareness is so important,” she said. “This is a growing problem, and many of the issues go unrecognized.”</p>